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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345920176
Report Date: 12/04/2025
Date Signed: 12/04/2025 04:19:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20251028090844
FACILITY NAME:GOLDEN AGE LIVING 1FACILITY NUMBER:
345920176
ADMINISTRATOR:SOUMAHORO, MUAMOUDOU AFACILITY TYPE:
740
ADDRESS:3375 LA CADENA WAYTELEPHONE:
(916) 389-9683
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 6DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Sylvia Anaeke and Helen ScarlettTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff did not respond to residents call button.
Staff left resident in a soiled diaper for a long period of time.
INVESTIGATION FINDINGS:
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On December 4, 2025, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to deliver the allegation of the complaint above. LPA met with staff and explained the purpose of the visit.

For the allegations, Staff did not respond to residents call button, and staff left resident in a soiled diaper for a long period of time, LPA conducted extensive interviews. Interviews conducted revealed that staff serve dinner at approximately 4:00 PM and "wraps up" residents at approximately 8:00 PM. Interview conducted with Licensee, confirmed dinner is typically served at 4-4:30 PM. Interview conducted with staff (S1) revealed that five out of six residents required incontinence care. Last depend change is completed at 8:00 PM. S1 stated there are two residents in care that tends to be awake throughout the night while the others sleep.

Please continue on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2025 and conducted by Evaluator Cassie Yang
COMPLAINT CONTROL NUMBER: 59-AS-20251028090844

FACILITY NAME:GOLDEN AGE LIVING 1FACILITY NUMBER:
345920176
ADMINISTRATOR:SOUMAHORO, MUAMOUDOU AFACILITY TYPE:
740
ADDRESS:3375 LA CADENA WAYTELEPHONE:
(916) 389-9683
CITY:SACRAMENTOSTATE: CAZIP CODE:
95835
CAPACITY:6CENSUS: 6DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Sylvia Anaeke and Helen ScarlettTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Staff did not serve a resident an adequate amount of food.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cassie Yang arrived at the facility to deliver the finding of the allegation cited above. LPA met with staff and explained the purpose of the visit.

During the course of the investigation, the department conducted extensive interviews and record reviews. Interview conducted with resident (R1) revealed that there is no concerns with food services at the facility. Interview conducted with resident (R2) revealed that facility provides food, but it tends to be Jamaican food served which tends to have too much spice for R2. Interview conducted with staff (S1) revealed that residents are provided with three meals a day along with snacks in between. Images of foods being served are typically sent to Licensee by staff, which copies were submitted to LPA. Images observed, it was determined to be adequate amount of food for residents in care.

Based on information above, the department concluded that the allegation is unfounded. A finding that an allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview and copy of report provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 59-AS-20251028090844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: GOLDEN AGE LIVING 1
FACILITY NUMBER: 345920176
VISIT DATE: 12/04/2025
NARRATIVE
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LIC 9099-C

Interview conducted with resident (R1) revealed that staff are "good at changing" in the day but if an incontinence accident occurs in the middle of the night, staff does not respond for changing. R1 stated this typically occurs around midnight and staff will assist with changing around 7:00 AM. Interview conducted with resident (R3) revealed that incontinence care at night does not exist. R3 stated R3 requires full assistance with incontinence care by staff, last depend change occurs after dinner around 5:00-6:00 PM. R3 reported no assistance is available around 8:30 PM. Interview conducted with resident (R4) revealed that there have been multiple occasions where R4 soiled themselves in the middle of the night. R4 stated R4 tries to use call lights at night for emergencies only since staff are sleeping, but majority of the time, staff does not wake up to the call light as it is located in the kitchen away from the staff room which is separated by a fire door. Interview with R4 further revealed that there was a night where call light was triggered approximately at 10:00 PM but staff did not wake up to the call so R4 was left sleeping in wet depends which leaked to the bedding until morning. R4 stated recently it has been one caregiver working at the facility, with one caregiver working periodically on-call, when the facility used to be staffed with two caregivers working at all times.

Based on the information obtained, the allegations are SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegations cited above are substantiated, please see LIC9099-D.



Exit interview conducted and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 59-AS-20251028090844
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: GOLDEN AGE LIVING 1
FACILITY NUMBER: 345920176
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/19/2025
Section Cited
CCR
87625(b)(2)
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87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.
This requirement is not met as evidenced by:
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Licensee is to submit a plan of how facility will ensure incontinent residents are routinely checked, especially the night.
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Based on interviews conducted, Licensee did not comply to the section cited above as resident interviews revealed that at night there is minimal assistance by staff for incontinence care which poses a potential risk for residents in care.
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This plan is to be submitted to LPA by December 19, 2025. Failure to complete plan of correction by due date will result to $100 civil penalty per day until received/corrected.
Type B
12/19/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by:
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Licensee is to submit a plan to LPA of how facility will ensure residents needs are met at all times as call lights are not responded to at night.
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Based on interviews conducted, Licensee did not comply as call lights for incontinence care are often not attended at night which poses a potential risk for residents in care.
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This plan is to be submitted to LPA by December 19, 2025. Failure to complete plan of correction by due date will result to $100 civil penalty per day until received/corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Cassie Yang
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4